Drug Facts - Heroin

Overview

Heroin is a highly addictive drug and is the most
widely abused and most rapidly acting of the
opiates. Heroin is processed from morphine, a
naturally occurring substance extracted from the
seed pod of certain varieties of poppy plants.

Pure heroin, which is a white powder with a bitter
taste, is rarely sold on the streets. Most illicit
heroin is a powder varying in color from white to
dark brown. The differences in color are due to
impurities left from the manufacturing process or
the presence of additives. Another form of heroin,
"black tar" heroin, is primarily available in the
western and southwestern U.S. This heroin, which is
produced in Mexico, may be sticky like roofing tar
or hard like coal, with its color varying from dark
brown to black.

Heroin can be injected, smoked, or sniffed/snorted.
Injection is the most efficient way to administer
low-purity heroin. The availability of high-purity
heroin, however, and the fear of infection by
sharing needles has made snorting and smoking the
drug more common. National Institute on Drug Abuse
(NIDA) researchers have confirmed that all forms of
heroin administration are addictive.

Extent of Use

According to the 2008 National Survey on Drug Use
and Health (NSDUH), approximately 3.8 million
Americans aged 12 or older reported trying heroin at
least once during their lifetimes, representing 1.5%
of the population aged 12 or older. Approximately
453,000 (0.2%) reported past year heroin use and
213,000 (0.1%) reported past month heroin use.

In 2008, there were 114,000 persons aged 12 or older
who had used heroin for the first time within the
past 12 months. The average age at first use among
recent initiates aged 12 to 49 was 23.4 years in
2008. There were no significant changes in the
number of initiates or in the average age at first
use from 2007 to 2008. The number of heroin
initiates was not significantly different from the
number in 2002 (117,000).

Among students surveyed as part of the 2008
Monitoring the Future study, 1.4% of eighth graders,
1.2% of tenth graders, and 1.3% of twelfth graders
reported lifetime use of heroin.

Approximately 75.5% of eighth graders, 83.1% of
tenth graders, and 73.2% of twelfth graders surveyed
in 2008 reported that using heroin occasionally
without a needle was a “great risk.” Additionally,
approximately 86.4% of twelfth graders surveyed in
2008 reported that using heroin regularly was a
“great risk.”

Regarding the ease by which one can obtain heroin,
13.3% of eighth graders, 17.2% of tenth graders, and
25.4% of twelfth graders surveyed in 2008 reported
that heroin was "fairly easy" or "very easy" to
obtain.

Approximately 0.5% of college students and 1.6% of
young adults (ages 19-28) surveyed in 2007 reported
lifetime use of heroin.

According to data from the Bureau of Justice
Statistics, approximately 23.4% of State prisoners
and 17.9% of Federal prisoners surveyed in 2004
indicated that they used heroin/opiate at some point
in their lives.

Health Effects

The short-term effects of heroin abuse appear soon
after taking the drug. Intravenous injection
provides the greatest intensity and most rapid onset
of the initial rush that users experience.
Intravenous users typically experience the rush
within 7 to 8 seconds after injection, while
intramuscular injection produces a slower onset of
this euphoric feeling, taking 5 to 8 minutes. When
heroin is sniffed or smoked, the peak effects of the
drug are usually felt within 10 to 15 minutes.

In addition to the initial feeling of euphoria, the
short-term effects of heroin include a warm flushing
of the skin, dry mouth, and heavy extremities. After
the initial euphoric feeling, the user experiences
an alternately wakeful and drowsy state. Due to the
depression of the central nervous system, mental
functioning becomes clouded. Additionally, breathing
may be slowed to the point of respiratory failure.

After repeatedly using heroin for a period of time,
the long-term effects of the substance begin to
appear in the user. Chronic users may develop
collapsed veins, infection of the heart lining and
valves, abscesses, and liver disease. Additionally,
pulmonary complications, including various types of
pneumonia, may also result in the user.

One of the most significant effects of heroin use is
addiction. With regular heroin use, tolerance to the
drug develops. Once this happens, the abuser must
use more heroin to achieve the same intensity or
effect that they are seeking. As higher doses of the
drug are used over time, physical dependence and
addiction to the drug develop.

Within a few hours after the last administration of
heroin, withdrawal may occur. This withdrawal can
produce effects such as drug craving, restlessness,
muscle and bone pain, and vomiting. Major withdrawal
symptoms peak between 48 and 72 hours after the last
dose and subside after about a week.

In addition to the effects of the drug itself, users
who inject heroin also put themselves at risk for
contracting HIV, hepatitis C (HCV), and other
infectious diseases. Approximately 70–80% of the new
HCV infections in the U.S. each year are among
injection drug users.

Street heroin is often mixed with various
substances, including sugar, starch, quinine, and
sometimes, strychnine or other poisons, causing an
added danger to using heroin. Because heroin abusers
do not know the actual strength of the drug or its
true contents, they are at a great risk of overdose
or death.

Of an estimated 113 million emergency department
(ED) visits in the U.S. during 2006, the
Drug Abuse Warning Network (DAWN) estimates that
1,742,887 were drug-related. DAWN data indicate that
heroin was involved in 189,780 ED visits.

Treatment

A variety of effective treatments are available for
heroin addiction. For example, methadone, a
synthetic opiate that blocks the effects of heroin
and eliminates withdrawal symptoms, has proven
successful for heroin addiction. Additionally,
buprenorphine and many behavioral therapies are also
used to treat heroin addiction.

From 1997 to 2007, the number of admissions to
treatment in which heroin was the primary drug of
abuse increased from 235,143 in 1997 to 246,871 in
2007. Heroin admissions represented 14.6% of the
total drug/alcohol admissions to treatment during
1997 and 13.6% of the treatment admissions in 2007.
The average age of those admitted to treatment for
heroin during 2007 was 36 years.

Arrests & Sentencing

During FY 2004, there were 32,980 Federal arrests
for drug law violations, 1,881 of which were for
heroin. Additionally, the Drug Enforcement
Administration (DEA) reported 2,273 arrests for
opiates in FY 2004.

During FY 2008, there were 1,476 Federal offenders
sentenced for heroin-related charges in U.S. Courts.
Approximately 97.3% of these cases involved
trafficking and 0.8% of cases involved simple
possession.

The Arrestee Drug Abuse Monitoring (ADAM) II program
is designed to gather information on drug use and
related matters from adult male offenders within 48
hours of arrest. ADAM II serves as a critical source
of data for estimating trends in drug use in local
areas, understanding the relationship between drugs
and crime, and describing drug market activity in
the adult male arrestee population in 10 U.S. sites
during 2008. Self-report data on recent use show a
consistently high frequency of use among arrestees
who use heroin. In 7 of the 10 sites arrestees who
admit heroin use report that they use it 15 or more
days out of the month.

Production & Trafficking

The U.S. heroin market is supplied entirely from
foreign sources of opium. Heroin available in the
U.S. is produced in four distinct geographical
areas: South America (Colombia), Southeast Asia
(primarily Burma), Mexico, and Southwest Asia
(principally Afghanistan).

Much of the heroin used in the United States comes
from poppies grown in Colombia and Mexico, though
opium gum production in these countries accounts for
less than 4% of the world’s total production and
Colombian production has been cut by 60% since 2001.
Mexico supplies most of the heroin found in the
western United States while Colombia supplies most
of the heroin east of the Mississippi. Colombian law
enforcement eradicated 375 hectares of opium poppy
in 2007, while the Government of Mexico (GOM)
reported eradicating 7,784 hectares of opium poppy.

According to 2006 Federal-wide Drug Seizure System
(FDSS) data, Federal agencies seized 1,774 kilograms
of heroin. FDSS contains information about drug
seizures made within the jurisdiction of the United
States by the DEA, Federal Bureau of Investigation,
U.S. Customs Service, U.S. Border Patrol, and U.S.
Coast Guard.

Legislation

Heroin was first synthesized from morphine in 1874
and became widely used in medicine in the early
1900s. At that time, physicians were unaware of
heroin's potential for addiction. The first
comprehensive control of heroin in the U.S. occurred
with the Harrison Narcotic Act of 1914. Heroin
currently falls into Schedule I of the Controlled
Substances Act based on its potential for abuse and
its lack of accepted medical use.